Florence Nightingale: Social Theory and Methodology
Paper for the ASA Meetings, Toronto 1997
by Lynn McDonald
Dept. of Sociology, University of Guelph
Abstract
Florence Nightingale is remembered as the heroine of the Crimean War and acknowledged for her contributions to nursing, hospital reform and statistics. This paper presents her as a scholar, showing the range of her theoretical interests and linking the theory with her practical activities as a social reformer.
The paper specifically shows how Nightingale drew on Quetelet’s social physics framework, but went further than Quetelet in many respects. Nightingale herself was a pioneer researcher, who designed and sent out her own questionnaires, as well as analyzing the data and working on applying the results for social betterment.
The paper sets out Nightingale’s systemic approach to health care, with measures for prevention and health promotion, and systems for medical/nursing care, at home and in hospital, all to be monitored with appropriate statistics, collected at the national level (permitting international comparisons), the attempt to get the Census to deal with house, on down to the local and institutional level.
A section reports Nightingale’s work on gender roles, including the equal right of women to self-development and occupations, her criticism of the double sexual standard and the harsh treatment of prostitutes by the state.
Perhaps the most glaring omission from the list of the founders of sociology for the nineteenth century is Florence Nightingale (1820-1910).1 Nightingale, of course, was a famous woman in her time as the heroine of the Crimean War, the “lady with the lamp,” and is still well known as the chief founder (there were others) of the profession of nursing. She is also recognized as a reformer of hospitals but not in the sociology of medicine.2 That she was a pioneer collector and analyst of social statistics is now but seldom acknowledged.3 That she did original work in comparative religion has only recently emerged with belated publication of her writing on Egypt.4 This work on religion, incidentally, predates that of Max Weber and Emile Durkheim by more than fifty years! That she did crucial, pioneering work on the high mortality of women from childbirth is little known, nor that she claimed equal rights for women to develop their own lives, even “independent careers.” Rather, on status of women/gender role issues the tendency is either to place Nightingale on a pedestal for her work on nursing and her anguished writing about the family, or to trash her for her (admittedly real) occasional anti-women statements.
That Nightingale wrote what sociologists have called grand theory has scarcely been realized in social science, although this material has now been published and studied by people interested in religion.5 Still the only books on sociological theory to treat Nightingale as a significant contributor are my own Early Origins of the Social Sciences and Women Founders of the Social Sciences.6 The purpose of this paper is to present Nightingale as a serious contributor to the development of social science theory and methodology, in the case of the latter one who had an important impact at the time. This work is part of the preparation for a collected works of Florence Nightingale, to be published by Wilfrid Laurier University Press.
Nightingale’s writing style was lively and interesting. It poses difficulties for us today for its use of traditional male-oriented language (there are only occasional exceptions where she used gender-inclusive terms). Another difficulty for contemporary readers is her frequent use of “God-talk.” This was common enough among seventeenth and eighteenth-century social scientists, but had become rarer in her time, to become eccentric now. Adam Smith, in the eighteenth century, had a deist explanation of the “invisible hand,” or recourse to divine manoeuvres to keep society working. Nightingale’s concept of God was rather different, as creator of the world and its laws, who did not subsequently intervene. Readers should consider that references to “God’s thoughts” simply mean the laws that operate the universe, social as well as natural. Note also that Nightingale’s use of “moral” has no reference to morality, but is the older term for “social,” so that the “moral philosophy” of the eighteenth century means nothing other than what we would call “social science” today.
Nightingale’s closest allies were the Belgian mathematician and statistician L.A.J. Quetelet, especially for his Physique sociale,7 and J.S. Mill, whose System of Logic and (with co-author Harriet Taylor Mill) Principles of Political Economy, helped to shape British sociology as it emerged in the mid nineteenth century. (Mill, incidentally, was also a significant influence on Max Weber.) Nightingale, Quetelet and Mill were all meliorists, that is social scientists who sought to improve society (from the Latin melior, for “better”). They believed that knowledge, acquired from careful, thorough research, could be applied in the social world, for useful intervention.
Nightingale, in line with the Enlightenment tradition and with a religious faith that encouraged the same meliorist approach, sought to understand the laws that run the world, the social world in the same way as the physical, so that concerned people could intervene appropriately, for good. She saw the world as being created by God, and operating in a highly deterministic fashion. This did not lead, however, to the acceptance of existing conditions but to a strategy for intervention.
Nightingale had an uncanny ability to see the people in statistics. Mortality data meant dead individuals to her, lives cut off too soon. In a letter to a colleague she called it “as criminal to have a mortality of 17, 19 and 20 per thousand” in the Army when it was only 11 per 1000 in civil life, “as it would be to take 1100 men out upon Salisbury Plain and shoot them.”8
No wonder her best biographer, E.T. Cook, titled his chapter on her work on Quetelet and statistics “the passionate statistician“ (Part 4 chapter 2 of his Life of Florence Nightingale).
Nightingale called her mentor Quetelet the author of “the most important science in the world,” social physics, for on it depended all the others, that is, it provided the common methodology for application/intervention in all the social sciences. She also likened him to Plato, high praise indeed from a Plato scholar. Like Isaac Newton, still widely considered to have been the most important scientist in history, he was modest about his findings: “These are only a few pebbles picked up on the vast sea-shore of the ocean to be explored. Let the exploration be carried out.”9 Nightingale went much further than Quetelet (and Mill) in practising what they all believed. While Quetelet’s empirical analysis was confined to data already collected, by the Census or other government statistics, Nightingale conducted her own surveys. As well, she was much more insistent than Quetelet in the possibilities of practical application. While he worked overwhelmingly on demography and criminology she took on such major issues as the public health care system/preventive medicine, the prevention of famine and what we would call food security in India, and such social problems as the regulation of prostitution. She herself collected data (by mail) in India, Australia, New Zealand and, in a very limited way, Canada, while Quetelet remained tied to Europe and already published data from government statistics.
Because of the scale of the problems Nightingale worked on, like famine and disease in India and unnecessary mortality in war anywhere, Nightingale used royal commissions and official enquiries for data collection. For decades of her life she sent out her own questionnaires as well, to hospitals, maternity institutions, Army bases, the viceroys and governors of India and municipal governments in Britain, on public health, mortality rates, irrigation measures, agricultural practices, systems of taxation and local finance.
Nightingale’s Empiricist Methodology
Although many contemporary feminists have rejected empiricism in general and quantification in particular in the name of their feminist ideals, there is a substantial history of women theorists choosing empiricism precisely for its ability to liberate from authoritarian, patriarchal traditions. Nightingale shared her empiricist proclivities with such eminent women as Germaine de Staël, Harriet Martineau, Beatrice Webb and Jane Addams. But she was even more committed as a number cruncher, the ultimate passionate statistician.
Nightingale subscribed to all the defining characteristics of empiricism: nominalism, the search for laws, probability as the goal, hypotheses as means, with rigorous research methods and a common method with the natural sciences, at least in principle. Nightingale’s references to natural science were virtually all favourable. The only, qualified, exception concerns
Darwinism, perhaps social Darwinism more particularly, which she considered rested on too few observations (she utterly rejected the harsh political ideology associated with social Darwinism). Natural science was ahead of social science in developing scientific method, thanks to the work of Francis Bacon and Isaac Newton in the seventeenth century. It was, accordingly, a model for social science, but social science methodology would have to be distinct, sharing only the basic principles. In a paper to International Statistical Congress Nightingale contrasted progress in astronomy and medical and health science, that the vast amount of data collection in the latter, without uniform nomenclature and classification, was like “an indefinite number of astronomical observations made without concert and reduced to no common standard.”10
Nightingale was familiar enough with the history of natural science to use examples from it in her writing, notably Newton’s test of his law on gravitation. On the publication of the first results from the introduction of pollution abatement technology in Britain she wrote its author with congratulations.11 Robert Angus Smith’s reports on acid gas emissions led to his publishing the first full-scale book on acid rain in 1872.12 Nightingale grasped the significance of his research from his annual reports.
Nightingale’s Quetelet
Nightingale was a careful student of Quetelet’s work. She referred to the original French edition, although using its subtitle,13 but did not seem to know its English translation, A Treatise on Man.14 She also knew his Lettres sur la Théorie des Probabilités appliquées aux sciences morales et politiques, 1845, a work dedicated to the Prince Consort, who had studied probability theory with him,15 Anthropométrie16 and Système social.17 Quetelet gave her a copy of the expanded (French) edition of Sur l’homme, 1869, now with the subtitle as the main title: Physique sociale.18 Nightingale annotated her copy extensively, wrote out and translated excerpts and started to cite Quetelet in her essays, published and unpublished.
Quetelet himself was influential in the emerging social science of Britain as well as in his own country, France and the Continent generally. He had attended the founding meeting of the statistics section of the British Association for the Advancement of Science, held in Cambridge 1834. He chaired the International Statistical Congress, held in London in 1860. That congress, incidentally, was opened by Prince Albert, Quetelet’s former pupil. The meeting was the occasion of the only meeting between Nightingale and Quetelet. Quetelet was esteemed no less by Karl Marx, who praised Physique sociale as “an excellent and learned book,” using his average man concept in the development of the labour theory of value.19
The following excerpts show what Nightingale took from Quetelet and how it grounded her own methodology:
Moral laws of God can be found by induction as by physical laws. Indeed God’s moral, social and physical laws act and react on one another. By Quetelet’s method moral laws can be stated in numerical results. If anything can be called a law, is not that the effects of which can be prophesied like and eclipse?20
A law does not “govern” or “subordinate,” does not compel people to commit crime or suicide. On the contrary, it put means into our hands to prevent them, if we did but observe and use these means. It simply reduces to calculation observed facts; this is all that a law means. These laws or results change of course with the causes which give them birth, for example, civilization, sanitary and moral, changes the law on mortality by diminishing the death rate. So it is with the law of morality. The causes influencing the social system are to be recognized and modified. From the past we may predict the future.21
The influence of civilization, of political and religious institutions, on the moral and physical nature of man is at present little known as an exact science, still less as an art by which to do perfectly that which we now do gropingly and in the dark….Above all it is governments which dispose of life. Is it not then the first, the most essential step to have a political science—to raise it, if it is a science at all, into an exact science—to determine the actual results of legislative measures, and political institutions in figures, not to go in this blind way, changing laws almost at random, at the caprice of party, but to make that an art which is the most essential of all arts.22
Nightingale was astute and sceptical enough to have a healthy respect for the scope of unintended consequences from any kind of social intervention. Thus she advocated systematic evaluation of all new programs, especially if they cost the public purse much.
Nightingale’s first analysis of data, for the Royal Commission on the Sanitary Condition of the Army prompted her to create new ways of portraying statistics graphically. She used a series of bar charts to make comparisons between the mortality in the army and the civilian population. These were soon extended to compare mortality in the army in peacetime (or the poor sanitary conditions of barracks) and that of the civilian population (not in barracks). She used bar charts a little later also in a tribute to Sidney Herbert,23 to show how, under his administration (and her advice) mortality rates had declined dramatically. All these graphs are effective and accessible. She also managed to convey conditions of over-crowding well, with spatial representation using dots.
Her most ingenious graphs, however, were coxcombs, of which today’s pie charts are a pale imitation. Nightingale’s graphs were more complex, permitting longitudinal and cross-sectional analysis.24 The slices could have different radii, unlike the more limited pie chart so familiar in corporate and government annual reports. I have adapted the method to portray data on environmental pollution—carbon emissions; by giving several pies at different periods of time one can show increases in emissions, and the size of the slices (by country) show who the culprits are.
Nightingale’s graphical innovations were widely used, although not the full, more complicated coxcomb. Most notably her colleague William Farr, then Britain’s most eminent social statistician, introduced graphs into government reports (he worked for most of his career in the Registrar-General’s Department). Farr himself in 1858 proposed Nightingale for membership in the Statistical Society of London (later the Royal Statistical Society). In 1874 the American Statistical Association elected her an honorary member.25
Analysis of Health/Disease and the Health Care System
Nightingale’s formidable ability to think systematically was nowhere put to better use than in the analysis of health (what makes it and what makes disease) and health care (which included medical care, but much more). The basis of her approach came from her religious commitment:
The same tie really connects us to every one of our fellows as the tie which connects us with God; that to neglect or ill-use the imbecile old woman, the dirty child, is the same crime of lèse majesté against the Almighty that blasphemy of God is.26
Motivated by her religious philosophy, Nightingale was an early exponent of what economists call “human capital theory.” That is she saw that people, when adequately educated and trained and in good health, become productive members of society. People who got sick and could not pay for medical/nursing care at the time went into a “workhouse infirmary,” where they remained ill and unproductive. Providing them with good care not only was good religion but good economics, because it got people up and producing again. Workhouses in general, and workhouse infirmaries in particular, were not only cruel but were counter productive.
Not only are they torturing these poor fellows with unproductive labour at unremunerative prices, but the torture test is of no avail, for the workhouses are overflowing and the people are starving….The harm is the withdrawing all these heads and arms from production.27
Nightingale was not a socialist but she did see a role for the state in providing work, at least in times of high unemployment. She asked if it were not possible “that at least in exceptional times of distress the state could not give productive work at remunerative prices”.(f53) Good health required decent social conditions, work, adequate housing, clean air and water.
Treating people when they became ill was part of the system, but the more important part was the prevention of illness. Adequate care for children was logically the first step. Nightingale published Notes on Nursing, 1860, to give advice especially on good child care to build health.28 “Money would be better spent in maintaining health in infancy and childhood than in building hospitals to alleviate or cure disease. It is much cheaper to promote health than to maintain people in sickness.”29
Good housing was essential, for Nightingale recognized that its lack was directly responsible for much illness:
The state of the dwellings of the poor, the sanitary or rather un-sanitary state of London in general is not often taken into account in the ill health it produces, e.g. consumption, weakness of intellect, rheumatism. We only think of the “violent” and “sudden” deaths of typhus and cholera. Yet the poor cannot drain their own streets, nor reform their own dwellings. [Is it] not hard to visit our shortcomings (in making London unhealthy) upon the disease they engender by calling it pauperism, by treating the sick or imbecile like the able-bodied lazy, immoral paupers and tramps.30
“Those who come from the worst dwellings are always the most sickly,” she observed (f65). Nightingale noted to the great Victorian sanitarian Edwin Chadwick that improved morals required better living standards.
Even given the best measures for health promotion, disease prevention, some provision for the treatment of the ill had to be made. The precise nature of it should be determined on the basis of experience and be evaluated from time to time. Hospitals and medical care by physicians should not play too great a role. Nightingale was always sceptical about chemical, drug-oriented medicine. This is undoubtedly a major reason for her decided lack of keenness for women to enter the medical profession. She really did not think it did as much good as nursing.
Medicine does not cure. It is Nature only that cures. All that medicine has to do is to find out what prevents the operations of nature in curing, and then by the most careful accumulation of facts to ascertain what is the remedy to remove the obstruction out of Nature’s way, and how best to apply it.31
Where hospitals were required they had to be properly constructed and situated, a subject on which Nightingale made an enormous contribution. She sent papers to the annual meetings of the National Association for the Promotion of Social Science on hospital construction and sanitation and later had these reprinted as Notes on Hospitals.32 Her data analysis included occupational susceptibility to disease, notably the elevated rates of mortality among nurses and hospital attendants from communicable diseases, compared with the civilian population.
Nightingale also applied statistical method to such immediate, practical questions as the best location for a hospital.
In considering the possible removal of St Thomas’s Hospital, for a railway extension, she examined the addresses of cases within certain distances of the hospital, to show the probable effect upon patients on relocation to each of the proposed sites.
“This method of fitting hospital accommodation to the needs of populations has only recently been revived. It represents a legitimate application of demographic principles to the study of the relief of dire human needs.”33
At the time Nightingale was working on hospital reform the vast majority of people had access only to workhouse infirmaries, where there was no professional nursing care and only the occasional visit by a doctor. In effect the sick were mixed in with all the other destitute people.) Nightingale worked out the system that instituted the first care of the sick in workhouse infirmaries, setting out the principles for this in a memorandum to the President of the Poor Law Board, the person responsible for administering the existing system.
To insist on the great principle of separating the sick, insane, incurable and children from the usual pauper population of the metropolis;
To advocate a general metropolitan rate for this purpose and a central administration
To leave the pauper and casual population and the rating for under the Boards of Guardians, as at present; these are the A.B.C. of the reform required.
Centralize all the sanitary powers at present exercised by the Guardians; release them from these duties entirely; provide a scheme of suburban hospitals and asylums:
- for sick
- for infirm, aged and invalids
- for insane and imbeciles
- industrial schools for children.34
Nightingale was absolutely clear about the need for central administration and financing. The unit had to be large enough to permit cross-subsidization, or the taxes from richer areas helping to pay for the care of people from the poorer. She recommended a national administration as ideal: “All the officers of these infirmaries and asylums should be appointed by and should be responsible to the central authority, which is responsible to Parliament.” This made sense philosophically as well, because:
sickness, madness, imbecility and permanent infirmity are general afflictions affecting the entire community and are not (like pauperism) to be kept down [by punitive measures]. The sick or infirm or mad pauper ceases to be a pauper when so afflicted and should be chargeable to the community at large as a fellow-creature in suffering. Hence there should be a general rate for this purpose to be levied over the whole metropolitan area to be administered by the central authority (ff62-63).
The management of the whole scheme required statistics for each part. To give overall context and to provide basic data Nightingale sought the collection of national data on illness (and housing, a related issue) in the Census. She proposed, unsuccessfully, that a question on illness be added to the Census of 1861. “In this way we should have a return of the whole sick and diseases in the United Kingdom for one spring day, which would give a good average idea of the sanitary state of all classes of the population.” She pointed out that mortality returns did not take cognizance “of a large amount of disease which rarely proves fatal, but which nevertheless represents a vast loss of efficiency in the population.”35Questions on housing of course would become routine in the Census, and even some countries have included questions on illness.
The International Statistical Congress held in London in 1860 was the occasion to seek international co-operation in the collection of data on illness and its treatment. Nightingale sent a short paper, an appendix with details on her plan for uniform statistics and a letter with precise recommendations for the reform of hospital statistics, to the second section of the congress. Her message was that governments collect a great deal of statistical information on the prevalence of disease; the challenge was to take better advantage of such routinely-collected material. Delegates were asked to bring reports to the next congress that would show “marked examples of diminution of mortality and disease,” with the cost savings achieved. It was important to show the cost of not acting as well, for cost frightened communities from carrying out works necessary to ameliorate public heath. Both science and humanity would benefit by bringing the facts to public awareness.
Nightingale was sure that the data would show that the costs of prevention, for crime, disease and excess mortality, were less than the evils they addressed. In what we would call a “cost-benefit analysis,” she argued that the provision of data “would remove one of the most legitimate objections in the minds of governments and nations against such measures.”36
Nightingale’s one-page proposal on hospital statistics for the congress urged standardization, a “uniform plan” across countries for the keeping of hospital statistics. Comparisons would then be possible on relative mortality and the frequency of diseases and injury not only by class but by country and district. The extent to which lives were wasted by illness, by what diseases, at what ages, for particular kinds of disease, could thereby be accurately ascertained.
The relation of the duration of cases to the general utility of a hospital has never yet been shown, although it must be obvious that if, by any sanitary means or improved treatment, the duration of cases could be reduced to one-half, the utility of the hospital would be doubled, so far as its funds are concerned.
“Trustworthy data” were possible even for rare diseases and operations, by abstracting the results from tables after a long term of years. Future experience could be guided by the use of such data.37
There was a distinct role to be played at the local level as well in health promotion/disease prevention. Nightingale herself analyzed the local mortality statistics for the county she knew best, Buckinghamshire (where her sister and brother-in-law had their country home, where she frequently visited). She discovered that its mortality statistics were higher than for other similar areas and urged concrete action to bring them down. A local sanitary committee was established to work to this effect.
Midwifery brought out Nightingale’s feminism as well as challenging her methodologically. She had sought the establishment of what was then called a “lying-in” institution (maternity hospital) to facilitate the training of midwives. When it appeared that the mortality rates from puerperal fever were too high she closed it. In fact they were lower than rates in some Continental European hospitals. To make the right decision about midwifery training required knowledge of the “normal” mortality rate in childbirth. Because no comparative data existed Nightingale sent out questionnaires to various hospitals and workhouse infirmaries. The results were carefully analyzed and a their implications for practice set out.
With all their defects, midwifery statistics point to one truth, namely that there is a large amount of preventible mortality in midwifery practice and that, as a general rule, the mortality is far, far greater in lying-in hospitals than among women lying-in at home.38
Secondary influences, like the age of the mother, number of pregnancies and duration of labour, also had an impact. So did such conditions as the social class of the patient, her health and stamina before delivery the time kept in midwifery wards before and after delivery.
It might have been expected that women in workhouses, because of their poverty and worse health generally, would have higher mortality rates than women giving birth in a midwifery institution. Instead their rates were lower (58). Nightingale concluded that the effect of the institution was greater than that of social conditions (65). This is an interesting conclusion and one with enormous practical implications.
The data also showed higher mortality rates where women were in contact with doctors and medical students. Nightingale drew the obvious conclusion that there should be as little medical involvement at all; medical students should be entirely banned (69). Giving birth, she asserted, was not an illness and lying-in cases were not sick cases (73). This view has considerable support now, especially from feminists, but at the time midwifery was becoming medicalized. Midwifery wards at general hospitals should be closed and home births encouraged. Training institutions for midwives should be small so that conditions could emulate those of home births. They could only be justified if they were as safe for birthing mothers as home deliveries. With characteristic concern for funding the system she argued that: “having made up our minds what is necessary for this purpose we must pay for it” (71).
Gender Roles
Nightingale lived at the time that votes for women first became an issue in Britain. She was a friend of J.S. Mill, who asked her to join the suffrage society and sign its petition, which he introduced into the House of Commons in 1866. She declined at first, but on his pressing acceded.39 Apart from the fact that she had access to the political notables, initially from her prominent family background, later from her own fame, Nightingale did not think political rights as important for women as economic rights. She put her efforts into getting women access to useful, satisfying and decently-paid jobs, notably nursing.
More broadly, Nightingale believed that women had equal rights with men to develop their talents, to fulfill their aspirations. A sizzling, unpublished essay on the family, 1870, described its being in a state of war. She decried both the Roman Catholic repudiation of the family in favour of religious orders, and the Protestant tendency to glorify it hypocritically and hide its defects. She enlisted her religious beliefs: “Christ’s whole life was a war against the family.” She also recognized that Christ’s statement that his brothers and sisters were those who loved his Father in heaven would be considered “subversive of all morality” in normal society.40
If the family was, by divine design, the basic social unit, yet it was also true that God made “love of action, desire in each man and woman for self-development, for a free career according to his or her ability….The best family education is that which gives opportunities of development and of acquiring independence, and the worse education is that which stifles them” (f11). There is not much resemblance between Nightingale’s position and that of the religious right. She cited a Biblical passage on joy when “a man is born into the world,” pointing out that “a woman must be born into the family….But what joy is there in her being born into the smallest of all possible spheres, which will exercise perhaps no single one of her faculties?” (f15). She likened the frittering away of women’s abilities to robbery and murder, for people were robbed of their time and some were “slowly put to death,” even in homes that were “estimable and virtuous,” by the stifling treatment of their families (f18).
Moreover, “faculties not utilized and developed in youth rarely come to hand afterwards when they are wanted. So we see the helpless, unhandy minds or the petty tyrants of this youthful generation become the fathers and yet more the mothers of as helpless, unhandy minds, as of tiresome petty tyrants in the next generation” (f25). Political economy might have had something to teach on this point, but it often left out the most valuable element, the development of human faculty, “the giving to each man or woman the highest and freest career according to his or her ability, developed according to its highest ideal” (f26).
For all that was wrong with the family for women, Nightingale yet saw it as the basic institution of society, unassailable by the forces of Communism (f1). She used empirical evidence to argue the superiority of the family to institutions like asylums or schools for the care of children. Even the best institutions did not succeed as well as good poor families in raising children (f3). Thus, at a time when large institutions were the norm, Nightingale recommended boarding out, or fostering, as the means of looking after abandoned or otherwise parentless children. Fostering created artificial families for these children. Institutional care failed by not developing feeling. This tension, between the need for individual contact, hence private charity to help people, and systemic change, to ensure adequate funding, can be seen throughout her writing on social policy.
Nightingale asserted the same fundamental equality between the sexes in her analysis of prostitution. The issue of the day was a practical one. In the early 1860s the British government sought to bring in (and shortly did) legislation ostensibly to combat syphilis in the armed forces, by resorting to the compulsory examination and treatment of women prostitutes. (There was no compulsory examination or treatment of the men.) Nightingale succeeded only in slowing down the introduction of the Contagious Diseases Acts, the first of which was adopted by Parliament in 1864, and amended several times in the 1860s. They remained the law of the land until repeal in 1886, after a lengthy battle led by Josephine Butler.41
Nightingale’s analysis, which was shared by the later repeal movement, was based on this fundamental egalitarianism. The double standard was then almost universally accepted, that men had a greater need of sex than women, consequently that they had to have recourse to prostitutes when unable to marry or without their wives (as in foreign Army bases or ports for Navy men). As a result the Army and Navy facilitated access to prostitution. Nightingale and later opponents of the legislation insisted that there was no radical disjunction in nature or moral obligation between men and women. She and they instead focussed on the social factors that prompted recourse to prostitutes: excessive use of alcohol, bad diet, inadequate work and leisure facilities. They argued for changes in social conditions for the men instead of criminal sanctions against the women. (Nightingale also advocated tough measures to go after the pimps.)
At the request of the War Office in 1862, Nightingale prepared a briefing note on the subject of compulsory examination and treatment. Its full title is suggestive of her conclusions: “Note on the Supposed Protection afforded against Venereal Disease by Recognizing Prostitution and putting it under Police Regulation.” She used comparative statistics from jurisdictions with and without compulsory examination and treatment, which showed wide variation in rates of syphilis and that the compulsory measures had not in practice worked.42 There was no tendency for venereal disease to be reduced where police regulation was in force, but even slightly lower rates of admission into hospital in places without regulation than those with. “The assumed protection of the troops at Malta, Gibraltar and Corfu [which had police regulation] is simply a myth.”
Not lacking nerve, Nightingale argued for the suppression of prostitution as a better solution, on the grounds of the long-term, even inter-generational, consequences of venereal disease. There was more reason to legislate against prostitution than against theft!
As to the etiology of prostitution itself Nightingale repudiated the standard explanation of her day of “depravity” in favour of economic factors, especially for occasional prostitutes, and abusive home conditions (we would say incest and child sexual abuse). She cited data showing increased numbers of prostitutes with increasing recession, as unemployed or under-employed women workers temporarily turned to the sex trade. A letter to Henry (later Cardinal) Manning described prostitution as “the most lucrative profession in England, except the stage, for a woman. Those who do not follow it as a trade help themselves out with it, as the miserable earnings of needlework are nothing like enough to satisfy a woman’s wants.”43 Nightingale accepted the conventional view of prostitution as a moral wrong, but simply considered it (and sexual immorality generally) as less harmful than many other things. (Organized blunders, especially the mismanagement of government departments, were much worse.)
Social Physics and their Practical Application
There is an interesting correspondence between the two as Nightingale tried to convince him of the need for the scheme.
Galton’s biographer, the statistician Karl Pearson (of Pearson’s r) considered her letter formulating the proposal as “one of the finest that Florence Nightingale ever wrote.”44 Galton ultimately failed, being content to have a few lectures sponsored, not an ongoing chair. Nightingale had difficulty convincing him of the need for practical application; she corrected his draft title of “application to the solution of important social questions” to “practical application to social problems” (2:423). She had had “social physics” in the original proposal, no doubt in honour of Quetelet; he substituted “statistical science.”45
Hygiene and public health were more studied in England than any other branch of statistics, but there were still some gaps, notably the effect of bad nutrition on the schooling of poor children. Nightingale’s main case, however, was the failure to use the statistics already available, even splendid statistics, because a university education did not teach people how to use them. The examples she gave as priorities for research were of key social programs. In the case of education, legislation had been brought in twenty years earlier (Forster’s Education Act) instituting a mass public system; what was its effect? Was primary and secondary education a waste? “If we know not the effects upon our national life of Forster’s Act, is not this a strange gap in reasonable England’s knowledge?” (2:417) There were questions on the operation of workhouses, again on which large sums of public money were spent.
Nightingale had a series of questions on the effects of deterrence in the prison system. “Some excellent and active reformers tell us ‘whatever you do, keep a boy out of jail…once in jail always in jail, jail is the cradle of crime.’ Other equally zealous and active reformers say ‘a boy must be in jail once to learn its hardships before he can be rescued.’ strange that in practical England we know no more about this?” She asked specifically if education helped to reduce crime “or only to escape conviction, to steal better when released?” (2:417)
This last endeavour permitted a revisit of key Nightingale themes, thirty years after she had met Quetelet and nearly twenty years after she had written her “In Memoriam” essay. Singing his praises to Francis Galton she reminisced: “You know how Quetelet reduced the most (apparently) accidental carelessness to ever-recurring facts, so that as long as the same conditions exist, the same accidents will recur with absolutely unfailing regularity.” She now thought that the notion that social progress was possible, with application, had gained some, if vague, understanding, “that if we change the conditions for the better, the evils will diminish accordingly.” (2:418).
Notes
1 The best biography is still E.T. Cook, Life of Florence Nightingale. 2 vols. London: Macmillan 1913. See also Cecil Woodham-Smith, Florence Nightingale 1820-1910. London: Constable 1950; W.J. Bishop and Sue Goldie, eds., A Bio-Bibliography of Florence Nightingale. London: Dawson 1962.
2 Brian Abel-Smith, The Hospitals 1800-1948. London: Heinemann 1964. On her reform activities more generally see Raymond G. Herbert, ed., Florence Nightingale: Saint, Reformer or Rebel Malabar FL: Krieger 1981 and Vern Bulogh et al, eds., Florence Nightingale and her Era. New York: Garland 1990. Apart from the Diamond and Stone work on Nightingale’s Quetelet, which will be used here, there are three exceptions which give Nightingale her due:
3 Bernard Cohen, “Florence Nightingale,” Scientific American 246 (March 1984): 128-33, 136-37; Edwin W. Kopf, “Florence Nightingale as Statistician” Publications of the American Statistical Association 15 (1916-17) 388-404; Paul D. Stolley and Tamar Lasky, Investigating Disease Patterns: The Science of Epidemiology New York: Scientific American Library 1995:39-43.
4 Florence Nightingale, A Journey on the Nile 1849-1850, ed. Anthony Sattin. London: Barrie & Jenkins 1987. Florence Nightingale in Egypt and Greece: Her Diary and “Visions,” ed. Michael D. Calabria. Albany: SUNY Press 1997.
5 Suggestions for Thought by Florence Nightingale, ed. Michael D. Calabria and Janet A. Macrae. Philadelphia: University of Pennsylvania Press 1994 and Cassandra and Other Selections from Suggestions for Thought, ed. Mary Poovey. London: Pickering & Chatto 1991.
6 McDonald, Early Origins of the Social Sciences. Montreal: McGill-Queen’s University Press 1993 and Women Founders of the Social Sciences. Ottawa: Carleton University Press 1994.
7 First published in French as Sur l’homme et le développement de ses facultés. Paris 1835. It was next published in English as A Treatise on Man, trans. R. Knox. Edinburgh: 1842 (Scholars’ Facsimile reprint 1969). The version Nightingale used was the second and much expanded French edition: Physique sociale. 2 vols. Brussels: Muquardt 1869.
8 Cited by Kopf 390, letter to John McNeill.
9 Letter to Francis Galton 7 February 1891, Galton Papers, University College Archives.
10 Nightingale, Paper to the Second Section of the International Statistical Congress 1860.
11 Letter 15 June 1865, collection of Hugh Small.
12 Robert Angus Smith, Air and Rain: the beginnings of a chemical climatology. London: Longmans Green 1872.
13 Quetelet, Sur l’homme et le développement de ses facultés, ou essai de physique sociale. Paris: 1835.
14 Quetelet, A Treatise on Man and the Development of his Faculties, trans Ronald Knox. Edinburgh: Chambers 1842.
15 Available in English as Letters addressed to H.R.H. the Grand Duke of Saxe Coburg and Gotha on the Theory of Probabilities, as applied to the moral and political sciences, trans., Olinthus Gregory Downes. London: Layton 1849 [1845], Arno reprint 1981.
16 Quetelet, Anthropométrie. Brussels: Muquardt 1870.
17 Quetelet, Du Système social et des lois qui le régissent. Paris: Guillamin 1848.
18 Quetelet, Physique sociale. 2 vols. Brussels: Muquardt 1869.
19 Karl Marx, Selected Writings in Sociology and Social Philosophy, ed. T.B. Bottomore and M. Rubel. Harmondsworth: Penguin 1961:234.
20 British Library Nightingale Collection, Additional Manuscripts 45842 f51.
21 AM 45842 ff157-58, also published by Marion Diamond and Mervyn Stone, “Nightingale on Quetelet,” Journal of the Royal Statistical Society (series A) 144 (1981) Pt. 3:338.
22 AM 45842 ff195-97 and Diamond and Stone 349-50.
23 Nightingale, “Army Sanitation Administration, and its Reform under the late Lord Herbert.” London: McCorquodale 1862.
24 Nightingale, Notes affecting the Health, Efficiency and Hospital Administration of the British Army. London: Harrison 1858. The graphs were reproduced in Harriet Martineau, England and her Soldiers. London: Smith Elder 1859 and more recently in Cohen, op. cit.
25 Her acceptance letter was, characteristically, accompanied by a book of government statistics on India and her pamphlet “Life or Death in India,” then her dearest causes. Reproduced in Kopf, op cit., 395.
26 Draft letter to her father October 1867 Add Mss 45790 f358.
27 Private note 1 January 1868 Add Mss 45787 f51
28 A good critical edition of the expanded third edition is available, Florence Nightingale’s Notes on Nursing, ed. Victor Skretkowicz. London: Baillière Tindall 1996.
29 Nightingale, “Health and Local Government” 1894.
30 From a draft memorandum on the reform of hospital care, 1865, Add Mss 47753 f63.
31 Add Mss 45845 f4.
32 Originally titled “Notes on the Sanitary Condition of Hospitals and on Defects in the Construction of Hospital Wards.” Transactions of the National Association for the Promotion of Social Science. Liverpool 1858, reprinted as a pamphlet by Emily Faithfull, 1862. Notes on Hospitals. London: Longmans 1863 [which includes the above papers], reprinted in Florence Nightingale on Hospital Reform, ed. Charles E. Rosenberg. New York: Garland 1989.
33 Kopf op. cit:396.
34 Draft letter to Charles Villiers c July 1865 AM 47753 f61.
35 Letter to William Farr, 21 April 1860, AM 43398.
36 Letter from Miss Nightingale to the Second Section, International Statistical Congress, Proceedings of the International Statistical Congress 1860. See the proceedings for 17-20 July for the response to her recommendations.
37 Paper to the Second Section of the International Statistical Congress 1860.
38 Nightingale, Introductory Notes on Lying-in Institutions. London: Longmans, Green 1871:3 (reprinted in Florence Nightingale on Hospital Reform, ed. Charles E. Rosenberg New York:
39 In his Autobiography Mill acknowledged that he had only signed the crucial letter which persuaded her to change her mind; it had been written by Helen Taylor, his step-daughter and an active suffragist. Collected Works of John Stuart Mill, ed. John Robson. Toronto: University of Toronto Press 1981 16:1345.
40 AM 45843 f9.
41 McDonald, Women Theorists on Society and Politics, Waterloo: Laurier, 1998.
42 Nightingale, “Note on the Supposed Protection afforded against Venereal Disease.” London. Unpublished briefing note 1862.
43 Elisabeth J. Erb and Peter C. Erb, “Manning-Nightingale Texts,” AM 45796 ff1-8.
44 Karl Pearson, ed., Life, Letters and Labours of Francis Galton. Cambridge University Press 2:418. Original letters at University College Manuscripts, London.
45 Letter to Galton 7 February 1891
